Hypnotic therapy reduced spinal cord injury pain after six weekly remote sessions, outperforming usual care in a new study.
Six weekly remote sessions combining hypnosis with cognitive therapy significantly reduced pain intensity, compared with usual clinical care, among patients with spinal cord injury.
Senior author Mark P. Jensen, is professor of rehabilitation medicine at UW Medicine.
He said: “Not only did the study show that this treatment is effective, but unlike most medications used for pain, it is a treatment with many positive side effects, like improved sleep and a greater sense of self-control.
“I think that, based on the evidence, including the side-effect profile, this is the first treatment that people with chronic pain should be offered.”
About two-thirds of people with spinal cord injury experience chronic pain, which can significantly worsen disability and reduce quality of life.
Such pain is typically managed with physical therapy and pain medications.
Previous research has shown that cognitive therapy can reduce the perception of pain. It works on the idea that pain is processed in the brain and can be shaped by a person’s thoughts and beliefs.
Negative thoughts, such as believing pain will never go away, can intensify pain, while positive thoughts, such as believing relief is possible, can lessen it.
In this study, researchers looked at whether hypnosis could strengthen the effects of cognitive therapy by making patients more open to suggestions aimed at changing thoughts and beliefs about pain.
“Hypnosis helps patients be more open to ideas about changing their thinking and internalising those ideas, so they become automatic,” said first author Charles Bombardier, a UW Medicine psychologist and professor of rehabilitation medicine.
For the study, Bombardier and colleagues enrolled 127 patients with chronic pain due to spinal cord injuries. Their average age was 51.
On average, their injuries had occurred about 15 years earlier. Participants were randomly assigned to hypnotic cognitive therapy or to a continuation of usual care.
The therapy sessions were conducted by phone or via Zoom by co-author and research associate professor M. Elena Mendoza, who specialises in hypnosis.
In the hour-long sessions, Mendoza used hypnosis to induce a relaxed state of attentiveness intended to make patients more open to suggestions.
She then explored the patient’s thoughts and beliefs about pain and identified which ideas improved or worsened their experience.
Using this information, she made suggestions to encourage thoughts and beliefs that could beneficially change how participants perceived pain.
“We identified both helpful and unhelpful thoughts but focused on reassuring thoughts that help alleviate their pain and enhance coping.
“Then we reinforced those in the hypnosis sessions,” Mendoza said.
Patients were given recordings of each therapy session and were instructed to listen daily and practise self-hypnosis three times a day to reinforce the therapeutic suggestions.
They were also asked to assess their pain four times a week during the six-week study and during a six-week follow-up period.
At the start of the study, participants rated their pain intensity on a scale from zero to 10, with zero meaning no pain and 10 meaning the most severe pain they had ever experienced.
The average score for the hypnotic cognitive therapy group was 5.99, compared with 5.87 for the usual care group, a difference that was not statistically significant.
Participants who underwent hypnotic cognitive therapy reported that their pain intensity dropped to 4.83 at six weeks and fell further to 4.52 at 12 weeks.
These decreases were significantly greater than the decreases seen in the usual care group, which recorded scores of 5.82 at six weeks and 5.81 at 12 weeks.
“A lot of psychological interventions wear off,” said Bombardier, “but in this case the effect had actually increased at 12 weeks, six weeks after treatment had stopped.”
Depression severity also declined significantly more in the hypnotic cognitive therapy group than in the control group.
At 12 weeks, pain interference, a measure of how much pain disrupts daily activities, dropped significantly more in the treatment group.
At six weeks, sleep disturbance also declined significantly more with hypnotic cognitive therapy. The treatment was equally effective whether delivered by Zoom or telephone.
Overall, the therapy was well received, with 90 per cent of participants in the therapy group saying they were satisfied or very satisfied with treatment, 35 per cent reporting their pain was much or very much improved, 50 per cent saying their ability to manage pain was much or very much improved, and 46 per cent reporting a clinically meaningful reduction in pain.
“Pain affects almost every aspect of these patients’ lives, so it was great to see that after just six sessions conducted over six weeks, they were able to make so much progress,” Mendoza said.
